National

Why health experts don't want to talk about the benefits of moderate drinking

If publicans were scientists, then a paper written by researchers at Oxford University and published in late December in the journal Adaptive Human Behaviour and Physiology would by now be pinned to the wall of every front bar from Broome to Bruny Island.

The paper, ''Functional Benefits of (Modest) Alcohol Consumption'', was written by seven faculty members of the university's department of experimental psychology. Its authors concluded, after a series of studies in UK hostelries and an extensive literature review, that popping down to your local a couple of times a week and having a few jars with mates delivered both psychological and physical health benefits.

It may well be a conclusion to gladden the hearts of barflies and barkeeps across the nation, but it is by no means one shared by all researchers in the field of alcohol study.

This is made abundantly clear by the Oxford boffins in their introductory remarks.

"Perhaps because alcohol addiction has serious medical and social consequences, most research on alcohol use has focused on the effects of over-consumption," they wrote.

"Nonetheless, the fact that alcohol continues to be used, especially in social contexts, raises the question of why humans began to use it, and continue to use it so widely."

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In public discourse, at least, the message about alcohol is overwhelmingly about risks and dangers. These are very serious matters, but are the warnings about binges and addiction obscuring the findings of a growing body of research that suggests moderate, controlled, social drinking might deliver benefits for mental and physical health?

Well, yes, but there are good reasons why.

"It's really about the costs to the healthcare system," said Dr Ryan Tonkens, a bioethicist at Monash University.

"Alcohol consumption can lead to certain kinds of diseases that are totally preventable, and when these people are consuming too much alcohol – or consuming it in the wrong way – then they are contributing to competition for these sorts of healthcare resources.

"So the main issue, as far as bioethicists are concerned, is the scarcity of medical resources available, and a public health concern. One of the main reasons that the state wants its citizens to be healthy is the high cost of treating people who cause their own illnesses."

Alcohol's cost to healthcare is greater than just that arising from disease. There is also the high price and tragedy resulting from alcohol-linked violence and road trauma.

Nevertheless, there is also the fact that large numbers of people regularly enjoy a drink or two without tipping into high-risk behaviours. There are also studies that suggest moderate tippling reduces anxiety and stress, and may also provide a protective effect against certain types of heart disease, some forms of cancer, cognitive decline, and possibly Parkinson's disease.

"While the real and perceived excesses of 'binge drinking' have received considerable attention in policy, media and academic debates, the concept of 'sensible drinking' is poorly defined and has rarely been subject to empirical analysis," wrote University of Loughborough cultural sociologist Dr Thomas Thurnell-Read in a paper published in March last year.

Thurnell-Read was writing in relation to craft beer festivals, alcohol-centred events at which participants "highlight self-control and social regulation as central features of acceptable drinking practices".

The practice of sensible drinking, he suggested, draws "on notions of taste, sociability and self-control".

All of which is lovely, if you can afford the hefty ticket price at beer fests, and find it entertaining to spend hours comparing the hoppiness of Indian pale ales before forking out more cash on a taxi home.

For some people – especially older people – "sensible" alcohol consumption is so defined because the idea of not drinking seems very unwise. Dr Christina Bryant, from the school of psychological sciences at the University of Melbourne, uses a different term to describe this practice. She calls it "drinking to cope".

In a co-authored study published this month, Bryant and her colleagues looked at 288 older alcohol consumers in rural Australia, and concluded that just over one-fifth them were "problem drinkers".

Among them were many who drank to cope. "Drinking-to-cope motives – to relax, to manage physical symptoms and to feel more self-confident – increased the odds of problem drinking," the paper concluded.

Bryant said that the habit didn't always lead to unhealthy outcomes, but was more likely to do so if the drinking wasn't coupled with other coping strategies, such as talking to people.

From that perspective, she saw valuable insight in the Oxford University study.

"The social aspect of drinking described in the Oxford paper is really critical – drinking with people in a social context would be inherently different from drinking on your own," she said.

"We also know that physical activity has added benefits when done socially rather than on one's own."

One of the criticisms levelled at studies that claim to find benefit in moderate social drinking is that they are a tad self-serving. Drinkers recruited into such research, the criticism runs, are likely to be healthy, educated, engaged with the idea, and therefore consistent in their habits and keen to participate.

By contrast, people whose drinking habits are variable, sliding sometimes into hazardous levels, are far less likely to get involved – and far more likely to drop out halfway through.

They are valid points and not without merit. However, in September last year Swiss health psychologist Dr Gerhard Gmel reviewed several recent studies and concluded that even when all the potentially complicating factors were taken into account, the beneficial effect "remained strong".

"We should also not forget that evidence is not based solely upon observational research," he wrote. "An integrated system of multiple biological pathways and biomarkers has been found providing support that moderate alcohol use may, in fact, be protective."

Also last September, Gmel and colleagues published another study looking at levels of drug use among young Swiss adults who didn't drink. The work found that non-drinkers carried a much higher risk of falling prey to heroin and ice than did moderate drinkers, concluding that abstinence, counter-intuitively, could be a very harmful practice.

No public health authority anywhere in the world, however, is likely to mount a campaign to encourage people to have a couple of bevvies every now and then. Not only would the political blowback be severe, any positives about alcohol consumption do not override Ryan Tonken's point about the high cost of alcohol-related preventable disease.

"A more nuanced approach to the ethics of alcohol consumption probably should pay more attention to the possible benefits," he said.

"I don't have a final answer as to why it doesn't. One suggestion is that it's just assumed that, as individuals older than the drinking age, they can decide for themselves if they want to consume alcohol.

"It is only the state's obligation to intervene when they start doing so in ways that are harmful to others."